title: Treatment and outcomes in carbapenem-resistant Klebsiella pneumoniae bloodstream infections.
abstract: Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) is an emerging multidrug-resistant nosocomial pathogen. This is a retrospective chart review describing the outcomes and treatment of 60 cases of CR-Kp bloodstream infections. All CR-Kp isolated from blood cultures were identified retrospectively from the microbiology laboratory from January 2007 to May 2009. Clinical information was collected from the electronic medical record. Patients with 14-day hospital mortality were compared to those who survived 14 days. The all-cause in-hospital and 14-day mortality for all 60 CR-Kp bloodstream infections were 58.3% and 41.7%, respectively. In this collection, 98% of tested isolates were susceptible in vitro to tigecycline compared to 86% to colistimethate, 45% to amikacin, and 22% to gentamicin. Nine patients died before cultures were finalized and received no therapy active against CR-Kp. In the remaining 51 patients, those who survived to day 14 (n = 35) were compared to nonsurvivors at day 14 (n=16). These patients were characterized by both chronic disease and acute illness. The 90-day readmission rate for hospital survivors was 72%. Time to active therapy was not significantly different between survivors and nonsurvivors, and hospital mortality was also similar regardless of therapy chosen. Pitt bacteremia score was the only significant factor associated with mortality in Cox regression analysis. In summary, CR-Kp bloodstream infections occur in patients who are chronically and acutely ill. They are associated with high 14-day mortality and poor outcomes regardless of tigecycline or other treatment regimens selected.
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Neuner
authors.forename: Jun-Yen
authors.initials: JY
authors.lastname: Yeh
authors.forename: Gerri S
authors.initials: GS
authors.lastname: Hall
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sekeres
authors.forename: Andrea
authors.initials: A
authors.lastname: Endimiani
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
authors.forename: Nabin K
authors.initials: NK
authors.lastname: Shrestha
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Fraser
authors.forename: David
authors.initials: D
authors.lastname: van Duin
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D015780:Carbapenems / Q000494:pharmacology*; D003091:Colistin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D000078304:Tigecycline; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D000078304:Tigecycline; C004691:colistinmethanesulfonic acid; D008911:Minocycline; D003091:Colistin